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Group Health's structure allows it to approach clinical quality differently from most traditional insurance companies, hospitals, and doctors. Group Health is a health care system that integrates care with coverage, and coordinates between specialties and other services. Its doctors and other clinicians are also supported by a research center and innovative technologies.
Group Health is a national leader in providing consistently high-quality care. Our model of coordinated care is built with the patient at the center: It doesn't stop when a personal physician refers a patient to a consultative specialist, physical therapist, pharmacist, visiting nurse, or other practitioner.
This integration offers special opportunities to improve clinical quality.
Pioneering Innovation
Group Health is a national leader in identifying quality measures, using them to improve quality, and reporting its quality measures to patients and the public. For example:
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In 1975, Group Health pioneered a computerized prescription drug system that gave doctors and pharmacists instant information about patients' drug histories, including allergies and potential interactions. |
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In 1984, Group Health was the major focus of the federally sponsored landmark Rand study of quality in coordinated-care settings. The study concluded that care at Group Health was as good or better than that in traditional settings, and its costs were lower. |
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In 1992, Group Health became one of the first health care systems to issue "report cards" on quality based on the national standard measures of "HEDIS" (Healthcare Effectiveness Data & Information Set), developed by the National Committee for Quality Assurance (NCQA). |
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In 2005, Group Health finished implementing the first phase of a state-of-the-art clinical information system that supports both personal physicians and their patients in a number of ways, including computerized physician order entry functions for pharmacy and ambulatory care, a major improvement in ensuring patient safety. |
Components of Group Health's Quality Program
Group Health's quality program includes:
Evidence-based medicine is the foundation for treatment and care. It is medicine that uses the best available medical research — not folk wisdom, tradition, fads, or marketing pressures. For example, Group Health never covered Vioxx because our researchers, physicians, and pharmacists who evaluated the drug had concerns about its safety based on their analysis of related studies.
Population-based medicine looks at individuals in the context of the different groups to which they belong-such as those with certain chronic conditions. This allows health teams to identify and individualize the most effective preventive care and treatments for each person in a systematic, thorough way. For example, Group Health's Breast Cancer Screening Program, which began in 1986, was one of the first to regularly identify women at risk and customize early-detection efforts.
Patient safety. Group Health has had a methodical, disciplined approach to patient safety and clinical improvement since its founding. It pioneered many of the patient safety approaches recommended by the National Academy of Science's Institute of Medicine.
Priority areas focus resources where improvements will have the greatest impact on peoples' health, as well as helping to make care as affordable as possible. This approach, which Group Health helped develop, has been adopted widely. It can been seen in initiatives such as flu-shot campaigns and participation in the Leapfrog Group, an association of corporate, government, and union leaders dedicated to improving patient safety.
Clinical information systems are a key tool in 21st century medicine. They organize clinical data in ways that allow health care teams to practice with greater knowledge, efficiency, and relevance for individual patients. Group Health's nationally recognized clinical information system goes farther, providing a Web-based interface for patients to securely e-mail their doctors, review and track test results over time, and see a summary of their visits and medical records.
Case management focuses attention on improving care across many areas for specific high-risk patients, such as diabetic or frail elderly patients. Group Health coordinates social work, patient education, and community and clinical resources across different kinds of care a patient might need.
Consumer involvement. Group Health's quality management policy is set by the consumer-elected Board of Trustees, which also conducts oversight activities. There is a formal grievance procedure and a patients' bill of rights and responsibilities.
Report Cards and Improvements
Clinical quality and patient safety is an ongoing process of setting and meeting ever-more-rigorous goals. Quality and safety thrive in a transparent and blame-free environment in which health care systems, their staff, and patients freely acknowledge and discuss areas of improvement.
That's why Group Health has long supported — in many cases, helped develop — and participated in initiatives such as:
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HEDIS Quality Compass "report cards", (PDF) sponsored by the National Committee for Quality Assurance. |
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The Institute of Medicine's recommendations to improve the nation's health care by focusing on safety, effectiveness, patient focus, timely care, efficient care, and care that is of equal quality to all regardless of income, location, gender, or ethnicity. Group Health participated in the task force that created the recommendations and we have created our own Quality Plan & Program (PDF). |
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The Hospital Quality Initiative, an industry-developed, federal program that provides hospital-quality data to the public via Medicare's Hospital Compare Web site. Group Health measures and monitors the quality of care provided by its contracted hospitals through the The Leapfrog Group and Hospital Compare Web sites.
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Institute for Healthcare Improvement's 100K Lives Campaign, to save 100,000 lives a year by using evidence-based medicine. Group Health was a leader in getting every Washington hospital to agree to participate. |
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The Leapfrog Group, which focuses on several hospital care standards to improve patient safety. Group Health supports Leapfrog standards, and its customers include Leapfrog sponsors, such as The Boeing Co. and the Machinists Union.
Leapfrog asks hospitals to adhere to four practices that research shows reduce unnecessary deaths and injuries. The practices are:
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Use of computers to order medications, tests, and procedures (Computerized Physician Order Entry) |
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Performing certain high-risk procedures in hospitals that have lots of experience and good results for those procedures (Evidence-Based Hospital Referral) |
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Intensive care units that are staffed by doctors and other caregivers who have special training in critical care |
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Processes that reduce preventable medical mistakes (Leapfrog Safe Practices Score) |
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In addition, Group Health is accredited by the National Committee for Quality Assurance (NCQA) and has received the highest "Excellent" rating through 2010. Group Health's hospitals and laboratory are accredited by the Joint Commission on Accreditation of Healthcare Organizations.
In 2007, "Best Health Plans" collaborated for the third consecutive year to rank the nation's commercial, Medicare, and Medicaid health plans. Nationally, Group Health's Medicare plan was ranked 22nd among 192; its commercial plan placed 98th out of 314. Group Health’s Medicaid plan was ranked 90th out of 199 plans.
The U.S. News health plan ranking merges many performance measures into a single scale. The ranking is based on clinical quality and member satisfaction information from HEDIS and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), as well as NCQA accreditation scores.
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